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[A case report: coronary artery bypass grafting for the patient with essential thrombocythemia]
Insights
Essential thrombocythemia, a blood disorder, can cause severe coronary artery disease. Successful treatment involved lowering platelet counts and coronary artery bypass grafting, resolving angina symptoms.
Area of Science:
- Cardiology
- Hematology
Background:
- Essential thrombocythemia (ET) is a myeloproliferative neoplasm characterized by elevated platelet counts.
- ET can lead to thrombotic and hemorrhagic complications, impacting various organ systems.
Observation:
- A 53-year-old male presented with progressive effort angina.
- Coronary angiography revealed a completely occluded left anterior descending artery with collateral supply.
- Diagnosis of ET was confirmed by a platelet count >1,000,000/mm3 and a history of bleeding tendency.
Findings:
- The patient's coronary artery disease was deemed secondary to ET, supported by a history of cerebral infarction due to carotid artery thrombus.
- Treatment involved Melphalan to reduce platelet count, followed by successful coronary artery bypass grafting using the left internal thoracic artery.
- Post-operatively, the patient remained asymptomatic on Melphalan, warfarin, and dipyridamole therapy.
Implications:
- This case highlights the critical link between essential thrombocythemia and coronary artery disease.
- Effective management of ET is crucial for preventing and treating cardiovascular complications.
- Multidisciplinary approaches involving hematology and cardiology are essential for managing complex ET-related cardiovascular events.
Abstract:
A 53-year-old man was suffered from progressive effort angina. Coronary angiogram revealed complete obstruction of the left anterior descending artery with collaterals from posterior descending artery. The essential thrombocythemia was diagnosed from platelet count over 1,000,000/mm3 with bleeding tendency. And hyperlipidemia was not observed. After the platelet count was reduced into normal range by administration of Melphalan, coronary artery bypass grafting using the left internal thoracic artery was performed successfully. The main cause of his coronary artery disease was thought to be secondary to the essential thrombocythemia as his past history included cerebral infarction secondary to transient thrombus formation in the common carotid artery which was confirmed with cerebral angiography. He has been on melphalan, warfarin and dipyridamol therapy after the operation without chest symptom.